COMMENTARY: Doctors must help fight opioid epidemic

I’m no stranger to the dentist’s chair, so I was surprised when, after my most recent tooth extraction, the specialist handed me a prescription for OxyContin.

By Rick HolmesGatehouse Media Columnist

I’m no stranger to the dentist’s chair, so I was surprised when, after my most recent tooth extraction, the specialist handed me a prescription for OxyContin. I’d never been offered anything stronger than Tylenol with codeine. OxyContin is a more powerful, more addictive opioid, and it’s helping kill people at an alarming rate.

I don’t recall the dentist telling me anything about how addictive OxyContin, known generically as oxycodone, is. Nor did she ask about addiction in my family history, or about any previous use of opioids, both of which are risk factors for addiction.

She wasn’t operating a “pill mill” or doing anything illegal – or at all unusual. U.S. pharmacies filled 207 million prescriptions for opioids in 2012, almost three times as many as in 1991. A lot of them were prescribed for purposes – like pain from having a tooth pulled – they wouldn’t have been used for just a few years ago. That’s been the pharmaceutical companies’ business plan, and it worked.

Those prescriptions are behind America’s addiction epidemic. They are used, shared and abused. And when the people in their grip can’t get or can’t afford any more, they turn to heroin. Four out of five heroin users started out by misusing prescription opioids, President Obama noted at an event in West Virginia last week announcing a new set of public and private initiatives to address the opioid crisis.

Several years into that crisis, the death toll continues to grow. Across the country, 100 people die every day from opioid overdoses. Here in Massachusetts, at least 1,089 people died from overdoses last year. State officials released preliminary data this week showing 414 overdose deaths in the first quarter of this year, up from 347 in the first quarter of 2014.

Chances are you know one of the victims, or someone in an overdose victim’s family. This crisis hits every community, every age group, every income level.

This crisis started in the doctor’s office, and federal and state policymakers are now turning to the doctors, and other medical professionals, to play a greater role in ending it.

There’s much to be done, Michael Botticelli told a group of Boston-area health care reporters in a video conference the day before Obama’s West Virginia event. Medical schools must do more to train physicians in pain management and addiction treatment. Physicians and public agencies must make better use of the prescription monitoring programs intended to catch doctor-shoppers and pill mills. More physicians must be trained in “medication-assisted treatment,” an effective and under-utilized tool for treating opioid dependence.

Botticelli, director of the White House Office of National Drug Control Policy – known as the “drug czar” everywhere except on his letterhead – is the right messenger for the moment. A longtime official in the Massachusetts Department of Public Health, he’s the first drug czar that doesn’t have a background in law enforcement or the military. He’s also the first drug czar to admit to personal experience with addiction. He speaks often about his struggles with alcoholism, about waking up handcuffed to a hospital bed after a drunk driving accident on the Mass. Pike, and about his 26 years in recovery.

That kind of candor is essential to getting rid of the stigma that keeps people from getting the treatment they need. Addiction is a chronic medical disease, not a character flaw, criminal act or moral failure, he said. He avoids terms like addict, abuser or addiction, which reinforce the stigma, preferring the more clinical, if somewhat awkward, “substance use disorder.”

Health professionals must treat substance use disorder as seriously as other conditions, Botticelli said. That means screening for risk factors before prescribing opioids, just as they screen for cancer or heart disease. It means treating problems early instead of waiting for a crisis.

“We don’t wait for someone with hypertension to have a heart attack before we treat them,” he said.

In West Virginia, Obama announced new training requirements for physicians and other prescribers working in federal health programs and improved access to treatment. He announced commitments from more than 40 private sector health providers to double the number of physicians trained in medication-assisted treatment, provide opioid training to 540,000 prescribers, increase the availability of naloxone, which can reverse opioid overdoses, and to enlist more than 4 million health care providers over the next two years “to be a part of the solution.”

On Beacon Hill, the Senate has OK’d a bill requiring school nurses to question middle and high school students about opioid abuse. Gov. Charlie Baker proposes limiting new opioid prescriptions to 72-hour doses to keep unneeded pills from falling into the wrong hands, and to empower hospitals to hold patients for up to 72 hours for involuntary addiction treatment. All these proposals have provoked questions and objections.

When policy prescriptions don’t work, we need to throw them out and try new ideas. That process should include the oldest idea in the book for dealing with substance use disorder: making it against the law.

“Arresting and incarcerating people with substance use disorder has been really ineffective, hugely expensive and inhumane,” Botticelli said. We can do better.

Rick Holmes writes for GateHouse Media and the MetroWest Daily News. He can be reached at rholmes@wickedlocal.com. Like him on Facebook at Holmes & Co. and follow him @HolmesAndCo.

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